STAKEHOLDER IN-DEPTH INTERVIEW GUIDE PURPOSE The Stakehlder In-Depth Interview Guide cntributes t understanding the scale-up prcess by asking key stakehlders t evaluate what has been achieved in scaleup, understand their perspectives regarding expansin and integratin f the innvatin, factrs and envirnmental frces that have influenced scale-up, and identify actins needed t supprt the innvatin and its expansin. Stakehlders were individuals wh had sme invlvement with SDM scale-up, including representatives f the MOH/gvernment, bilateral prjects, USAID implementing agencies, dnrs and multi-lateral rganizatins, prfessinal assciatins and civil sciety rganizatins including FBOs, lcal NGOs, and wmen's rights rganizatins. HOW IT WAS DEVELOPED AND USED Nine t eighteen stakehlders nt necessarily the same peple were interviewed in each cuntry at baseline and at endline. Interviewers cmpiled results f all the interviews and analyzed trends in respnses. Baseline study results infrmed r reinfrced strategic planning decisins. Endline study results were particularly useful in understanding the current envirnment and what needed t be dne t ensure that scale-up was sustained. Acrss cuntries, study results cntributed t identifying cmmn determinants f scale-up, particularly plitical and envirnmental frces, and issues ging frward. LESSONS LEARNED It is imprtant t interview a diverse grup f stakehlders, including thse wh are nt supprtive f the innvatin. This allws fr cmparisn f different perspectives n the innvatin s value and rle in the system. The ExpandNet framewrk elements were used t develp questins t gather pinins and perceptins f stakehlders and shed light n what had been achieved in scale-up. The interview fcused n tpics related t institutinalizatin f the innvatin, the reasns fr prgress (r lack theref) including envirnmental frces, and recmmendatins fr next steps. IRH field staff identified a range f key rganizatins invlved in family planning, and invited individuals wh were influential in family planning and SDM scale-up t participate in an interview t discuss the scaleup prcess. In each cuntry, a cnsultant familiar with SDM scale-up was hired t cnduct interviews using the in-depth interview guide. The baseline instrument did nt wrk as well as expected. It was nt sufficiently fcused n seeking respndent s analysis f envirnmental and system factrs that culd influence scale-up. The tl was significantly revised fr the endline, and included visual aids (in particular benchmark tables and maps) that culd be shared with interviewees t encurage system-riented reflectins. The mst effective apprach t the interview prved t be rganizing the discussin guide accrding t a systems framewrk and beginning by sharing a brief verview f the ExpandNet framewrk and Stakehlder In-Depth Interview Guide 1 f 6
a snapsht f scale-up prgress using the benchmark tables as a visual aid. The type f in-depth interview guide thematic and pen-ended required skilled interviewers with agile prbing skills. Interviewers needed t be cnversant with scale-up cncepts and the particular innvatin in rder t elicit relevant, detailed infrmatin. Interviewers had t be perceived as unbiased s that stakehlders felt cmfrtable sharing negative perceptins f the innvatin r the scale-up prcess. Individuals directly invlved in the innvatin scale-up wuld likely nt be gd candidates fr this task. VALUES The individuals interviewed were key decisinmakers and leaders in family planning, their values and pinins twards SDM as well as their analysis f institutinal values and pinins prvided infrmatin that culd be used t assess hw leader and rganizatinal values may have cntributed t the success r failure f SDM scale-up prcess and utcmes. Infrmatin btained frm these interviews ffered insight int the relative imprtance that the innvatin s cre values played in cnvincing gvernment ministries, health rganizatins, and service prviders f the cntributin f adding the innvatin t their prgrams. KEY REFERENCES & RESOURCES Wrld Health Organizatin/ExpandNet, 2010. Nine steps fr develping a scale-up strategy. http://whqlibdc.wh.int/publicatins/2010/978 9241500319_eng.pdf Stakehlder In-Depth Interview Guide 2 f 6
STAKEHOLDER IN-DEPTH INTERVIEW GUIDE Backgrund: [Describe implementing/resurce rganizatin, prject, and scale-up phase.] In rder t assess the integratin f [innvatin] int family planning and reprductive health services in [fcus cuntries/cuntries/area f implementatin], [rganizatin] is cllecting data thrugh [list applicable data surces ie, husehld surveys, facility assessments and stakehlder interviews and frequency]. Results will be used t make changes in integratin strategies and fcus, capture lessns learned, measure prject accmplishments and impact, and reprt t the gvernments f prject cuntries and t [dnr, ther interested parties(if applicable)]. Purpse: T evaluate what [rganizatin] has achieved in scaling up [innvatin], understand stakehlders perspectives regarding [innvatin] scale-up, cntribute t understanding the prcess f scale-up, and identify actins t be taken t supprt expanded, sustained services. Objectives: 1. Understand stakehlders views/definitins f scale-up and in particular [innvatin]scaleup 2. Determine stakehlders perspective f extent f success/failure f [innvatin] scale-up and their analysis f factrs that have affected scale-up success/failure 3. Determine stakehlders current cmmitment t and attitudes tward [innvatin]; evaluate changes, and cause f changes, in stakehlder attitudes regarding [innvatin] and integrating it int their prgram. 4. Determine what remains t be accmplished fr [innvatin] scale-up and wh will d it 5. Educate stakehlders in what [rganizatin] has accmplished regarding [innvatin] scale-up Preparatin: The interviewer shuld be familiar with each individual interviewee s backgrund and degree/type f invlvement in the scale-up prcess, psitin, and knwledge f scale-up. Apply this infrmatin t persnalize the questins. Interview Materials: - Benchmark tables - Lgframe inputs/utputs - Map f [innvatin] cverage in the interviewee s cuntry ver time (if available) Ptential types f interviewees: - Plicymakers - Representatives f technical assistance and dnr agencies - Representatives f private fr-prfit prvider netwrks - Prgram managers, including managers in capacity building - Assciatin f pharmacists r service prviders (in sme cuntries) Stakehlder In-Depth Interview Guide 3 f 6
In-Depth Interview Guide Name f Persn Interviewed: Title: Institutin/Organizatin: Date f Interview: Persn cnducting the interview: READ THE FOLLOWING GREETING BEFORE BEGINNING THE INTERVIEW: Hell, my name is. I am representing [rganizatin]. As yu may knw, [rganizatin] is wrking t intrduce [innvatin] int family planning services. We are cnducting a study t dcument the prcess f intrducing [innvatin] in yur cuntry. As part f this study, I wuld like t ask yu sme questins abut scaling up family planning innvatins like [innvatin] int reprductive health and family planning services in general, and integratin f [innvatin] specifically. This interview shuld take apprximately 45 minutes t an hur. Yur participatin is entirely vluntary; there is n penalty t yu if yu decide nt t participate. Yu nly need t respnd t thse questins yu wish t answer and yu may stp the interview at any time. We will include yur ideas in ur reprt, but we will nt use yur name, and will take care that yur cmments cannt be attributed t yu. Please read the infrmed cnsent frm. (Allw respndent time t read cnsent frm) D yu have any questins? D yu agree t participate in the interview? (Ask respndent t sign cnsent frm) May I tape recrd ur cnversatin? MAJOR THEMES, QUESTIONS AND PROBES: 1. Understanding f Scale-Up All gvernments use scale-up mdels, whether they are written r implicit, t help integrate a best practice int their prgrams r t help expand access t a best practice in a systematic way. Hw d yu understand scale-up? What d yu understand scale-up t be? [Organizatin] used the ExpandNet framewrk t guide, plan and evaluate [innvatin] scale-up effrts with partners. Under the ExpandNet framewrk, scale-up is defined as deliberate effrts t increase the impact f tested health service innvatins t benefit mre peple and fster sustainable plicy and prgram develpment. (Revise this paragraph as necessary t reflect the scale-up mdel chsen.) (Shw participant ExpandNet framewrk and explain different cmpnents.) Accrding t this apprach, the innvatin wuld be the interventins r best practices that are being Stakehlder In-Depth Interview Guide 4 f 6
scaled up. The resurce team refers t the individuals r rganizatins that will prmte and facilitate wider use f the innvatin. The user rganizatin refers t the rganizatins that will adpt r implement the innvatin. The envirnment refers t the cnditins that affect scale-up, such as plitical, ecnmic and scial factrs. The scale-up strategy is made up f different types f scale-up, such as plitical and gegraphical expansin, disseminatin appraches, rganizatinal prcesses, resurce mbilizatin, and mnitring and evaluatin. (Revise this paragraph as necessary t reflect the scale-up mdel chsen.) Have yu seen this mdel befre? D yu think a mdel like this is helpful? Why? What d yu cnsider indicatrs f successful scale-up? 2. Scale-Up Prcess & Extent T Which Scale-Up Principles Were Applied Can yu describe hw [innvatin] scale-up was peratinalized in yur prgram/rganizatin? What has wrked well? What hasn t wrked well? T what degree was a mdel/strategic apprach t planning applied? Describe. Hw des it differ frm ther wrk yu re ding in expanding prgrams? Wh has been invlved? Hw has that changed? In what way, if at all, wuld yu say the prcess cntributed t systems strengthening? Are yu familiar with any data/evidence f [innvatin] scale-up? Fr example, [mentin data cllected-.i.e, quality assurance data, midline assessment results, service statistics, Mst Significant Change (MSC) stries]. T what extent has the evidence/data cllected arund [innvatin] been used t supprt scale-up? There are many external factrs that may influence [innvatin] scale-up activities within the larger plitical-scial envirnment and amng the different rganizatins invlved. Are there any external factrs that have influenced [innvatin] scale-up in the last fur years? Hw have plitical envirnment and gvernment transitins played a rle? What has been the participatin f varius actrs in this prcess? Have there been any champins that have played a significant rle? If s, please describe. Hw has the cncept f human r reprductive rights played a rle? T what extent, if any, d yu think the wrk arund [innvatin] has invlved gender equity? [Revise r add questins that address values f the innvatin.] Hw has [rganizatin] helped t make this happen? What culd have been dne differently? 3. Degree Of [Innvatin] Scale-Up in the Cuntry and Organizatin [Shw and explain Benchmarks Summary Table (see (link t Benchmarks)) by indicatr.] Take a mment t lk at these scale-up benchmarks. Tell me what catches yur attentin. [Prbe by elements f Benchmark Prgress Summary (Fr prgram managers and representatives f private rganizatins)]: In regards t prvisin f family planning methds, t what degree has [innvatin] been fully integrated int yur rganizatin/prgrams? Why is that? Why nt? Stakehlder In-Depth Interview Guide 5 f 6
Is [innvatin] included as part f yur prgram/rganizatin s methd mix/service fferings? Are prviders trained t cunsel n [innvatin]? What type f prviders are best suited t ffer the [innvatin]? What are prviders perceptins regarding [innvatin] efficacy? Des [innvatin] integratin affect r influence the verall family planning training fr prviders? Is [innvatin] included in yur prgram/rganizatin s lgistics system? Is the [innvatin] included in the HMIS and reprting systems f yur prgram/rganizatin? Is [innvatin] included in yur prgram/rganizatin s plans and budget? Is [innvatin] included in yur prgram/rganizatin s materials and activities t increase awareness f family planning methds/demand? D yu think enugh awareness has been generated abut this methd? If nt, what d yu think is needed t create greater awareness? What rle d prvider attitudes play? Why d yu think scale-up has been successful in sme areas mre than thers? [Prbe by elements f Benchmark Prgress Summary (Fr plicymakers and representatives f dnr and cperating agencies)]: In regards t [innvatin] inclusin in family planning initiatives and prgrams, t what degree has [innvatin] been fully integrated int yur rganizatin s initiatives/prgrams? Why is that? Why nt? Wuld yu say the [innvatin] is included in the cuntry s key plicies, nrms and guidelines? If nt, why nt? Is [innvatin] included in the cuntry s prcurement system? If nt, why nt? Is [innvatin] being included in the cuntry s natinal health surveys? If nt, why nt? What rle d prvider attitudes play? Des [innvatin] integratin affect r influence the verall family planning training fr prviders? Why d yu think scale-up has been successful in sme areas mre than thers? 4. Specific Questins Regarding [Innvatin] T what degree is [innvatin] cnsistent with yur prgram/rganizatin s current pririties in reprductive health and family planning? What d yu think are the benefits that [innvatin] brings t RH/FP prgrams in yur cuntry? Des it als bring any disadvantages? Please describe. What is the effect f adding [innvatin] t the methd mix? Is scale-up f [innvatin] an effective way f wrking with FP prgrams utside f the public sectr r at cmmunity level? Hw? Because f yur invlvement with [innvatin] scale-up, has yur perceptin f scaleup changed? In what way? 5. Next Steps What is needed t cmplete [innvatin] scale-up in yur cuntry? What is needed t sustain what has been achieved? Stakehlder In-Depth Interview Guide 6 f 6